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Comment & Response |

Economic Impact of Surgical Complications on Hospitals—Reply ONLINE FIRST

Mark A. Healy, MD, MS1,2,3; Justin B. Dimick, MD, MPH1,2,3,4
[+] Author Affiliations
1Department of Surgery, University of Michigan, Ann Arbor
2Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor
3Michigan Surgical Quality Collaborative, University of Michigan, Ann Arbor
4Surgical Innovation Editor, JAMA Surgery
JAMA Surg. Published online August 31, 2016. doi:10.1001/jamasurg.2016.2309
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In Reply The letters by Chidambaram et al and Rosenberg et al raise an important point regarding the evaluation of the contribution margin and the total profit margin in the context of hospital cost accounting. Eappen et al,1 in their seminal JAMA article from 2013, studied a 12-hospital system in Georgia demonstrating evidence of perverse financial incentives for hospitals when surgical complications occur. They chose to study the contribution margin, an important factor for the short-term financial well-being of hospitals, for all of the reasons that they have outlined in their study.1 In our study, we chose to primarily evaluate the total profit margin, including fixed costs, as it relates to long-term financial solvency for hospitals. Moreover, this is an important perspective for hospitals at or near full operating room capacity, such as many large academic health systems.

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August 31, 2016
Swathikan Chidambaram, BSc(Hons); En Lin Goh, BSc(Hons); Simon Erridge, BSc(Hons)
1School of Medicine, Imperial College London, London, England
JAMA Surg. Published online August 31, 2016.;():. doi:10.1001/jamasurg.2016.2307.
August 31, 2016
Barry Rosenberg, MD, MBA; Bennett Lane, MS; Atul Gawande, MD, MPH
1The Boston Consulting Group, Chicago, Illinois
2Harvard Medical School, Boston, Massachusetts
3Ariadne Labs, Brigham and Women’s Hospital and Harvard T. H. Chan School of Public Health, Boston, Massachusetts
JAMA Surg. Published online August 31, 2016.;():. doi:10.1001/jamasurg.2016.2308.
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